Interpretation of the Global Strategy for the Diagnosis，Management，and Prevention of COPD 2019 by GOLD

doi:10.12114/j.issn.1007-9572.2019.00.064

Abstract

Abstract: The Global Initiative for Chronic Obstructive Lung Disease （GOLD）（2019 Report） was released on November 7，2018.The updates of the report involve the risk factors，diagnosis，prevention of COPD，management of stable COPD，management of exacerbations，and pharmacological and non-pharmacological treatments.The report focuses on the initiation pharmacological treatment，management cycly and follow-up pharmacological management of stable COPD according to the individualized assessment of symptoms and exacerbations.It also emphasizes the use of peripheral blood eosinophil counts as a biomarker to guide the use of inhaled corticosteroid therapy for exacerbation prevention.Here is an interpretation of the report.

Key words: Pulmonary disease, chronic obstructive；Initial pharmacological treatment；Management cycle；Follow-up pharmacological management；Blood eosinophil counts；Glucocorticoids

摘要： 慢性阻塞性肺疾病全球倡议（GOLD）2019于2018-11-07发布，更新涉及慢性阻塞性肺疾病（COPD）的危险因素、诊断、预防、稳定期及急性加重期的管理、药物治疗及非药物治疗等诸多方面。重点在于对稳定期COPD患者的药物治疗路径从“初始治疗”“管理循环”和“随访调整治疗”三个方面建立管理循环，并首次纳入血嗜酸粒细胞计数作为指导吸入糖皮质激素临床应用的生物标志物。本文旨在对GOLD 2019的重要更新内容进行介绍。

关键词: 肺疾病, 慢性阻塞性；初始治疗；管理循环；随访调整治疗；血嗜酸粒细胞计数；糖皮质激素类

WANG Xiaojuan,FANG Xiangyang. Interpretation of the Global Strategy for the Diagnosis，Management，and Prevention of COPD 2019 by GOLD　[J]. Chinese General Practice, 2019, 22(18): 2141-2149. DOI: 10.12114/j.issn.1007-9572.2019.00.064.
王晓娟,方向阳. 慢性阻塞性肺疾病全球倡议2019：慢性阻塞性肺疾病诊断、治疗与预防全球策略解读[J]. 中国全科医学, 2019, 22(18): 2141-2149. DOI: 10.12114/j.issn.1007-9572.2019.00.064.

References

［1］LOZANO R，NAGHAVI M，FOREMAN K，et al．Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010：a systematic analysis for the Global Burden of Disease Study 2010［J］．Lancet，2012，380（9859）：2095-2128．DOI：10.1016/S0140-6736（12）61728-0.
［2］MATHERS C D，LONCAR D.Projections of global mortality and burden of disease from 2002 to 2030［J］．PLoS Med，2006，3（11）：e442．DOI：10.1371/journal.pmed.0030442.
［3］SANA A，SOMDA S M A，MEDA N，et al．Chronic obstructive pulmonary disease associated with biomass fuel use in women：a systematic review and meta-analysis［J］．BMJ Open Respir Res，2018，5（1）：e000246．DOI：10.1136/bmjresp-2017-000246.
［4］ASSAD N A，BALMES J，MEHTA S，et al．Chronic obstructive pulmonary disease secondary to household air pollution［J］．Semin Respir Crit Care Med，2015，36（3）：408-421．DOI：10.1055/s-0035-1554846.
［5］TOWNEND J，MINELLI C，MORTIMER K，et al．The association between chronic airflow obstruction and poverty in 12 sites of the multinational BOLD study［J］．Eur Respir J，2017，49（6）：1601880．DOI：10.1183/13993003.01880-2016.
［6］BERAN D，ZAR H J，PERRIN C，et al．Burden of asthma and chronic obstructive pulmonary disease and access to essential medicines in low-income and middle-income countries［J］．Lancet Respir Med，2015，3（2）：159-170．DOI：10.1016/S2213-2600（15）00004-1.
［7］GERSHON A S，WARNER L，CASCAGNETTE P，et al．Lifetime risk of developing chronic obstructive pulmonary disease：a longitudinal population study［J］．Lancet，2011，378（9795）：991-996．DOI：10.1016/S0140-6736（11）60990-2.
［8］BIGNA J J，KENNE A M，ASANGBEH S L，et al．Prevalence of chronic obstructive pulmonary disease in the global population with HIV：a systematic review and meta-analysis［J］．Lancet Glob Health，2018，6（2）：e193-202．DOI：10.1016/S2214-109X（17）30451-5.
［9］DING Z，WANG K，LI J，et al．Association between glutathione S-transferase gene M1 and T1 polymorphisms and chronic obstructive pulmonary disease risk：a meta-analysis［J］．Clin Genet，2019，95（1）：53-62．DOI：10.1111/cge.13373.
［10］US Preventive Services Task Force（USPSTF），SIU A L，BIBBINS-DOMINGO K，et al．Screening for chronic obstructive pulmonary disease：US Preventive Services Task Force Recommendation Statement［J］．JAMA，2016，315（13）：1372-1377．DOI：10.1001/jama.2016.2638.
［11］HAROON S，ADAB P，RILEY R D，et al．Predicting risk of undiagnosed COPD：development and validation of the Target COPD score［J］．Eur Respir J，2017，49（6）：1602191．DOI：10.1183/13993003.02191-2016.
［12］JORDAN R E，ADAB P，SITCH A，et al．Targeted case finding for chronic obstructive pulmonary disease versus routine practice in primary care （Target COPD）：a cluster-randomised controlled trial［J］．Lancet Respir Med，2016，4（9）：720-730．DOI：10.1016/S2213-2600（16）30149-7.
［13］CALVERLEY P M A，ANDERSON J A，BROOK R D，et al．Fluticasone furoate，vilanterol，and lung function decline in patients with moderate chronic obstructive pulmonary disease and heightened cardiovascular risk［J］．Am J Respir Crit Care Med，2018，197（1）：47-55．DOI：10.1164/rccm.201610-2086OC.
［14］LIPSON D A，BARNHART F，BREALEY N，et al．Once-daily single-inhaler triple versus dual therapy in patients with COPD［J］．N Engl J Med，2018，378（18）：1671-1680．DOI：10.1056/NEJMoa1713901.
［15］BAFADHEL M，PETERSON S，DE BLAS M A，et al．Predictors of exacerbation risk and response to budesonide in patients with chronic obstructive pulmonary disease：a post-hoc analysis of three randomised trials［J］．Lancet Respir Med，2018，6（2）：117-126．DOI：10.1016/S2213-2600（18）30006-7.
［16］SIDDIQUI S H，GUASCONI A，VESTBO J，et al．Blood eosinophils：a biomarker of response to extrafine beclomethasone/formoterol in chronic obstructive pulmonary disease［J］．Am J Respir Crit Care Med，2015，192（4）：523-525．DOI：10.1164/rccm.201502-0235LE.
［17］PAPI A，VESTBO J，FABBRI L，et al．Extrafine inhaled triple therapy versus dual bronchodilator therapy in chronic obstructive pulmonary disease（TRIBUTE）：a double-blind，parallel group，randomised controlled trial［J］．Lancet，2018，391（10125）：1076-1084．DOI：10.1016/S0140-6736（18）30206-X.
［18］PASCOE S，LOCANTORE N，DRANSFIELD M T，et al．Blood eosinophil counts，exacerbations，and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease：a secondary analysis of data from two parallel randomised controlled trials［J］．Lancet Respir Med，2015，3（6）：435-442．DOI：10.1016/S2213-2600（15）00106-X.
［19］VESTBO J，PAPI A，CORRADI M，et al．Single inhaler extrafine triple therapy versus long-acting muscarinic antagonist therapy for chronic obstructive pulmonary disease （TRINITY）：a double-blind，parallel group，randomised controlled trial［J］．Lancet，2017，389（10082）：1919-1929．DOI：10.1016/S0140-6736（17）30188-5.
［20］ALISON J A，MCKEOUGH Z J，JOHNSTON K，et al．Australian and New Zealand Pulmonary Rehabilitation Guidelines［J］．Respirology，2017，22（4）：800-819．DOI：10.1111/resp.13025.
［21］LACASSE Y，BROSSEAU L，MILNE S，et al．Pulmonary rehabilitation for chronic obstructive pulmonary disease［J］．Cochrane Database Syst Rev，2002（3）：CD003793．DOI：10.1002/14651858.CD003793.
［22］SAHIN H，NAZ I，VAROL Y，et al．Is a pulmonary rehabilitation program effective in COPD patients with chronic hypercapnic failure?［J］．Expert Rev Respir Med，2016，10（5）：593-598．DOI：10.1586/17476348.2016.1164041.
［23］COULTAS D B，JACKSON B E，RUSSO R，et al．Home-based physical activity coaching，physical activity，and health care utilization in chronic obstructive pulmonary disease.Chronic obstructive pulmonary disease self-management activation research trial secondary outcomes［J］．Ann Am Thorac Soc，2018，15（4）：470-478．DOI：10.1513/AnnalsATS.201704-308OC.
［24］HORTON E J，MITCHELL K E，JOHNSON-WARRINGTON V，et al．Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation：a randomised noninferiority trial［J］．Thorax，2018，73（1）：29-36．DOI：10.1136/thoraxjnl-2016-208506.
［25］LENFERINK A，BRUSSE-KEIZER M，VAN DER VALK P D，et al．Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease［J］．Cochrane Database Syst Rev，2017，8：CD011682．DOI：10.1002/14651858.CD011682.pub2.
［26］KESSLER R，CASAN-CLARA P，KOEHLER D，et al．COMET：a multicomponent home-based diseasemanagement programme versus routine care in severe COPD［J］．Eur Respir J，2018，51（1）：1701612．DOI：10.1183/13993003.01612-2017.
［27］ROSE L，ISTANBOULIAN L，CARRIERE L，et al．Program of Integrated Care for Patients with Chronic Obstructive Pulmonary Disease and Multiple Comorbidities（PIC COPD+）：a randomised controlled trial［J］．Eur Respir J，2018，51（1）：1701567．DOI：10.1183/13993003.01567-2017.
［28］WALTERS J A，TANG J N，POOLE P，et al．Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease［J］．Cochrane Database Syst Rev，2017，1：CD001390．DOI：10.1002/14651858.CD001390.pub4.
［29］WEDZICHA J A，DECRAMER M，FICKER J H，et al．Analysis of chronic obstructive pulmonary disease exacerbations with the dual bronchodilator QVA149 compared with glycopyrronium and tiotropium （SPARK）：a randomised，double-blind，parallel-group study［J］．Lancet Respir Med，2013，1（3）：199-209．DOI：10.1016/S2213-2600（13）70052-3.
［30］CALVERLEY P M A，ANZUETO A R，CARTER K，et al．Tiotropium and olodaterol in the prevention of chronic obstructive pulmonary disease exacerbations（DYNAGITO）：a double-blind，randomised，parallel-group，active-controlled trial［J］．Lancet Respir Med，2018，6（5）：337-344．DOI：10.1016/S2213-2600（18）30102-4.
［31］WEDZICHA J A，BANERJI D，CHAPMAN K R，et al．Indacaterol-glycopyrronium versus salmeterol-fluticasone for COPD［J］．N Engl J Med，2016，374（23）：2222-2234．DOI：10.1056/NEJMoa1516385.
［32］LAHHAM A，MCDONALD C F，HOLLAND A E.Exercise training alone or with the addition of activity counseling improves physical activity levels in COPD：a systematic review and meta-analysis of randomized controlled trials［J］．Int J Chron Obstruct Pulmon Dis，2016，11：3121-3136．DOI：10.2147/COPD.S121263.
［33］BEAUMONT M，FORGET P，COUTURAUD F，et al．Effects of inspiratory muscle training in COPD patients：a systematic review and meta-analysis［J］．Clin Respir J，2018，12（7）：2178-2188．DOI：10.1111/crj.12905.
［34］CHARUSUSIN N，GOSSELINK R，DECRAMER M，et al．Randomised controlled trial of adjunctive inspiratory muscle training for patients with COPD［J］．Thorax，2018，73（10）：942-950．DOI：10.1136/thoraxjnl-2017-211417.
［35］CHUANG H Y，CHANG H Y，FANG Y Y，et al．The effects of threshold inspiratory muscle training in patients with chronic obstructive pulmonary disease：a randomised experimental study［J］．J Clin Nurs，2017，26（23/24）：4830-4838．DOI：10.1111/jocn.13841.
［36］BEAUMONT M，MIALON P，LE BER C，et al．Effects of inspiratory muscle training on dyspnea in severe COPD patients during pulmonary rehabilitation：controlled randomised trial［J］．Eur Respir J，2018，51（1）：1701107．DOI：10.1183/13993003.01107-2017.
［37］STOLZ D，HIRSCH H H，SCHILTER D，et al．Intensified therapy with inhaled corticosteroids and long-acting β2-agonists at the onset of upper respiratory tract infection to prevent chronic obstructive pulmonary disease exacerbations.A multicenter，randomized，double-blind，placebo-controlled trial［J］．Am J Respir Crit Care Med，2018，197（9）：1136-1146．DOI：10.1164/rccm.201709-1807OC.
［38］DING Z，LI X，LU Y，et al．A randomized，controlled multicentric study of inhaled budesonide and intravenous methylprednisolone in the treatment on acute exacerbation of chronic obstructive pulmonary disease［J］．Respir Med，2016，121：39-47．DOI：10.1016/j.rmed.2016.10.013.
［39］VAN VELZEN P，TER RIET G，BRESSER P，et al．Doxycycline for outpatient-treated acute exacerbations of COPD：a randomised double-blind placebo-controlled trial［J］．Lancet Respir Med，2017，5（6）：492-499．DOI：10.1016/S2213-2600（17）30165-0.
［40］NAGATA K，KIKUCHI T，HORIE T，et al．Domiciliary high-flow nasal cannula oxygen therapy for patients with stable hypercapnic chronic obstructive pulmonary disease.A multicenter randomized crossover trial［J］．Ann Am Thorac Soc，2018，15（4）：432-439．DOI：10.1513/AnnalsATS.201706-425OC.
［41］SELLARES J，FERRER M，ANTON A，et al．Discontinuing noninvasive ventilation in severe chronic obstructive pulmonary disease exacerbations：a randomised controlled trial［J］．Eur Respir J，2017，50（1）：1601448．DOI：10.1183/13993003.01448-2016.
［42］WALKER P P，POMPILIO P P，ZANABONI P，et al．Telemonitoring in chronic obstructive pulmonary disease（CHROMED）．A randomized clinical trial［J］．Am J Respir Crit Care Med，2018，198（5）：620-628．DOI：10.1164/rccm.201712-2404OC.

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